A 47-year-old man with constrictive pericarditis is undergoing an echocardiogram for follow-up. The sonographer asks you to explain the difference between the annulus reversus and annulus paradoxus phenomena.
Which of the following statements is correct?
A. Annulus reversus refers to reversal of septal and lateral mitral tissue Doppler velocities (E′ septal > E′ lateral) and annulus paradoxus refers to inverse correlation of E/E’ and LV end-diastolic pressureAnnulus reversus refers to reversal of septal and lateral mitral tissue Doppler velocities (E’ septal > E’ lateral) and annulus paradoxus refers to inverse correlation of E/E’ and LV end-diastolic pressure. The annulus reversus phenomenon describes a reversal of mitral lateral and septal tissue Doppler velocity. Normally, E’ lateral > E’ septal; however, in constrictive pericarditis it is postulated that tethering of the free wall prevents longitudinal motion of the annulus at the lateral border, thus decreasing the lateral E’ and the septal E’ concurrently is mildly exaggerated. The annulus paradoxus phenomenon was initially described after data looking at the correlation between the E/E’ ratio and pulmonary capillary wedge pressure were established. In a small subset of patients with constrictive pericarditis, inversion of the correlation between E/E’ and PCWP was noted, and named annulus paradoxus.